What are nonictal paroxysmal patterns on neonatal EEG?

Updated: Oct 03, 2019
  • Author: Rosalia C Silvestri-Hobson, MD; Chief Editor: Selim R Benbadis, MD  more...
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Nonictal paroxysmal patterns include the following:

  • Midline rhythmic bursts offer no diagnostic or prognostic clue when observed during non-REM sleep. These may represent the normal maturation ebouché of primitive sleep figures such as vertex waves.

  • Positive rolandic sharp waves (PRWs), first described by Cukier in 1972 as pathognomonic of IVH [8] , were considered poor prognostic indicators. Later studies by Tharp [9] and Lombroso were not as conclusive about the long-term clinical implications. Although PRWs are seen in 30–50% of PT infants with IVH, they also have been detected in infants with periventricular leukomalacia without hemorrhage as well as in intraparenchymal or subarachnoid bleeding. Therefore, PRWs are probably related to deep white matter lesions, although the underlying cause is still undetermined (see image below).

    Positive rolandic sharp waves R>L. Positive rolandic sharp waves R>L.
  • Positive temporal sharp waves (PTWs) are noted in the records of infants with hypoxic-ischemic damage and are thought to carry a poor prognosis. As with PRWs, the implications of the presence PTWs are still inconclusive.

  • Although rarely associated with ictal discharges, occipital spikes/sharp waves, whether isolated or in unilateral brief runs, are usually found in a population of high-risk infants and considered to be abnormal regardless of age.

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